PREOPERATIVE CHARACTERIZATION OF PIGMENTED SKIN-LESIONS BY EPILUMINESCENCE MICROSCOPY AND HIGH-FREQUENCY ULTRASOUND

Background and Design: Previous studies have referred to the value of epiluminescence microscopy in the differential diagnosis of pigmented skin lesions and to the possibility of preoperative tumor thickness me asurement in malignant melanoma by high-frequency ultrasound. Both non invasive methods have been combined in this study. The question of imp roved diagnostic accuracy was discussed. Previously proposed epilumine scence microscopic characteristics of 508 melanocytic lesions and sono graphic characteristics of 792 skin tumors were investigated for their sensitivity and specificity. The tumor thickness of 108 malignant mel anomas was measured sonographically. Results: Black dots, irregular pi gment network, and grayish-blue areas have been shown to be the most s ensitive characteristics, whereas pseudopods, grayish-blue areas, and a whitish veil have been shown to be the most specific epiluminescence microscopic features for malignant melanoma. Sonography alone cannot reliably distinguish between different skin tumors. Preoperatively, th e tumor thickness of 85% of the melanomas was assessed correctly conce rning the pT stage. Conclusions: A 20-MHz ultrasound, in addition to e piluminescence microscopy, may improve the diagnostic accuracy by deli vering information about depth and topographic location of skin tumors , but cannot give highly specific information about tissue dignity. It is a reliable tool for tumor thickness measurement for surgical plann ing.